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Menear M, Ashcroft R, Dahrouge S, Silveira J, Booton J, Emode M, McKenzie K. Person-centered care for common mental disorders in Ontario's primary care patient-centered medical homes: a qualitative study of provider perspectives. BMC PRIMARY CARE 2024; 25:278. [PMID: 39095749 PMCID: PMC11295484 DOI: 10.1186/s12875-024-02519-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND For more than a decade, the Patient-Centered Medical Home model has been a guiding vision for the modernization of primary care systems. In Canada, Ontario's Family Health Teams (FHTs) were designed in the mid-2000s with the medical home model in mind. These primary care clinics aim to provide accessible, comprehensive, and person-centered primary care services to communities across Ontario. Their services typically include mental health care for people experiencing common mental disorders, such as depression and anxiety disorders. It remains unclear, however, whether the mental health care delivered within FHTs is consistent with person-centered care approaches. In the current study, we aimed to explore the perspectives of FHT providers on the care delivered to people with common mental disorders to determine whether, and to what extent, they believed this care was person-centered. METHODS We conducted a qualitative grounded theory study involving interviews with 65 health professionals and administrators from 18 FHTs across Ontario. Transcripts were coded using a three-step process of initial, focused, and axial coding that mixed inductive and deductive approaches informed by sensitizing concepts on person-centeredness. RESULTS Practices and challenges associated with the delivery of mental health care in a person-centered way were captured by several themes regrouped into five domains: (1) patient as unique person, (2) patient-provider relationship, (3) sharing power and responsibility, (4) connecting to family and community, and (5) creating person-centered care environments. FHT providers perceived that they delivered person-centered care by delivering mental health care that was responsive, flexible, and consistent with biopsychosocial approaches. They emphasized the importance of creating long-lasting relationships with patients grounded in empathy and trust. Their challenges included being able to ensure continuity of care, adequately prioritizing patients' mental health issues, and meaningfully engaging patients and families as partners in care. CONCLUSIONS Our findings suggest that FHT providers have adopted a range of person-centered practices for people with common mental disorders. However, greater attention to practices such as shared decision making, supporting self-management, and involving families in care would strengthen person-centeredness and bring teams closer to the Patient-Centered Medical Home vision.
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Affiliation(s)
- Matthew Menear
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada.
- VITAM Centre de recherche en santé durable, Quebec City, Canada.
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Simone Dahrouge
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Jose Silveira
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jocelyn Booton
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Monica Emode
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Wellesley Institute, Toronto, Canada
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Kalocsai C, Agrawal S, de Bie L, Beder M, Bellissimo G, Berkhout S, Johnson A, McNaughton N, Rodak T, McCullough K, Soklaridis S. Power to the people? A co-produced critical review of service user involvement in mental health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:273-300. [PMID: 37247126 DOI: 10.1007/s10459-023-10240-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/07/2023] [Indexed: 05/30/2023]
Abstract
Meaningful service user involvement in health professions education requires integrating knowledge held by "lay" people affected by health challenges into professional theories and practices. Involving service users redefines whose knowledge "counts" and implies a shift in power. Such a shift is especially significant in the mental health field, where power imbalances between health professionals and service users are magnified. However, reviews of the literature on service user involvement in mental health professional education do little to explore how power manifests in this work. Meanwhile critical and Mad studies scholars have highlighted that without real shifts in power, inclusion practices can lead to harmful consequences. We conducted a critical review to explore how power is addressed in the literature that describes service user involvement in mental health professions education. Our team used a co-produced approach and critical theories to identify how power implicitly and explicitly operates in this work to unearth the inequities and power structures that service user involvement may inadvertently perpetuate. We demonstrate that power permeates service user involvement in mental health professional education but is rarely made visible. We also argue that by missing the opportunity to locate power, the literature contributes to a series of epistemic injustices that reveal the contours of legitimate knowledge in mental health professions education and its neoliberal underpinnings. Ultimately, we call for a critical turn that foregrounds power relations to unlock the social justice-oriented transformative potential of service user involvement in mental health professions education and health professions education more broadly.
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Affiliation(s)
- Csilla Kalocsai
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sacha Agrawal
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lee de Bie
- Centre for Clinical Ethics, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Gail Bellissimo
- Independent service user educator researcher, Toronto, ON, Canada
| | - Suze Berkhout
- University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Johnson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nancy McNaughton
- Wilson Centre for Research in Education at University Health Network and University of Toronto, Toronto, ON, Canada
- Michener Institute of Education at University Health Network, Toronto, ON, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kim McCullough
- Department of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Kemp D, Doyle M, Turner M, Hemingway S. Care Plan Templates in Adult Community Mental Health Teams in England and Wales: An Evaluation. NURSING REPORTS 2024; 14:340-352. [PMID: 38391071 PMCID: PMC10885041 DOI: 10.3390/nursrep14010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024] Open
Abstract
Adults accessing community mental health services are required to have a care plan, developed in collaboration with the person accessing the service. The variation in care plan templates in use in England and Wales, and their impact on care planning, is unknown. This study evaluates the community mental health care plan templates in use across England and Wales. Data were obtained from a Freedom of Information request to 50 NHS Mental Health Trusts. An evaluation tool was designed and used to extract data. Data were rated red, amber, or green against clinical and design standards. Forty-seven care plan templates were obtained. The clinical aspect of the care plan template had 60% adherence to the national standards, and the design aspects had 87% adherence. A 'high/low' typology is proposed against the design/clinical standards. The study identifies priority areas for improvement in the care plan templates as space to record the actions that service users and carers will take to contribute to their care plan, space to record the name and contact details for their care coordinator or lead professional, plus others involved in the person's care. This study was not registered.
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Affiliation(s)
- Donna Kemp
- School of Human and Health Sciences, Queensgate Campus, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Michael Doyle
- School of Human and Health Sciences, Queensgate Campus, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Mary Turner
- School of Human and Health Sciences, Queensgate Campus, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Steve Hemingway
- School of Human and Health Sciences, Queensgate Campus, University of Huddersfield, Huddersfield HD1 3DH, UK
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Shimange ME, Shilubane HN. Perspectives of Hospitalized Mental Health Care Users Concerning the Involvement of Family Members in Their Care: A Qualitative Study. NURSING REPORTS 2023; 13:1684-1694. [PMID: 38133115 PMCID: PMC10871100 DOI: 10.3390/nursrep13040139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
The value of families and professionals in mental health care is well understood. Patient perspectives appear to have gotten less attention to date. This study investigated the perspectives of hospitalized mental health care users on the involvement of family members in their care using a qualitative phenomenological design. The participants with lived experience of family members being involved in their care were chosen using non-probability, purposive sampling. Individual interviews were carried out with the assistance of a voice recorder and observation notes. Because of data saturation, only fifteen people were interviewed. The interviews were transcribed verbatim and analyzed using Colaizzi's method. It started with reading and reviewing the transcript to extract key statements about the phenomenon. The meaning was then determined by carefully studying the primary significant statements and phrases. The established meanings were then organized into themes and subthemes. The three themes that emerged from the data analysis are as follows: a wide variation in patients' perspectives when family members remind them of their medicine, unpredictable visitation by family members, and a lack of support from family members. There were also the following five sub-themes: not visiting mental health care users in the hospital causes uncertainty about their future, mental health care users were concerned by fewer visits from relatives, friends were perceived as a contributory factor to no or limited visitation by family members, disappointment by a lack of financial support, and perceived lack of emotional support from family members. There is a need for family members to visit mental health care users to remove uncertainty about their future. Healthcare providers should listen to mental health care users to identify the challenges they are faced with, and hospital policies tailored to enhancing the involvement of family members should be formulated.
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Affiliation(s)
| | - Hilda N. Shilubane
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
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Wazni L, Gifford W, Perron A, Vandyk A. Understanding the Physical Health Problems of People with Psychotic Disorders Using Digital Storytelling. Issues Ment Health Nurs 2023; 44:690-701. [PMID: 37549316 DOI: 10.1080/01612840.2023.2229435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
People with psychotic disorders struggle to be heard and express concerns beyond their mental health, especially concerns related to the side effects of treatment. Using digital storytelling, this study aimed to uncover and expose the underlying systems that oppress people with psychotic disorders from meeting their physical health needs. The stories revealed two themes: body as a contested site and biological entity with society, and (in)visible patient and paternalism. Spivak's theory of subalternity provided the theoretical basis for a critical analysis and discussion of the experiences. More research is required to highlight the power relations and structures that lead to health disparity in psychiatry.
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Affiliation(s)
- Liquaa Wazni
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Gifford
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Amélie Perron
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda Vandyk
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Pavarini G, Booysen C, Jain T, Lai J, Manku K, Foster-Estwick A, Gatera G, Omari Juma D, Karorero D, Philip-Joe K, Genevive Ukachukwu C, Sartor C, Zeitz L, Farmer M, Singh I. Agents of Change for Mental Health: A Survey of Young People's Aspirations for Participation Across Five Low- and Middle-Income Countries. J Adolesc Health 2023; 72:S96-S104. [PMID: 35279363 PMCID: PMC9747181 DOI: 10.1016/j.jadohealth.2021.10.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/19/2021] [Accepted: 10/26/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Effective intervention, policy, and research in mental health and well-being (MHWB) require young people to be understood not only as beneficiaries, but also as active agents in codesigning and implementing initiatives. To identify pathways for young people's participation in promoting MHWB in low- and middle-income countries (LMICs), this study surveyed young people's aspirations for engagement, their spheres of influence, capacity building needs, and key barriers to participation. METHODS Using U-Report, United Nations Children's Emergency Fund's social messaging tool and data collection platform, we distributed a short quantitative survey to a nonrepresentative, but large sample of young people aged 15-29 across five LMICs: Nigeria, Brazil, Jamaica, South Africa, and Burundi. RESULTS A total of 42,689 young people responded, with representation from most or all provinces within each country. Participants' average age was 23.8 years (SD = 3.77). Young people's core aspirations were to join a mental health awareness project and to support their peers. Participants considered schools and community settings to be the most important spheres for engagement. Lack of information about mental health was the main perceived barrier to participation, and mental health classes the main training need. DISCUSSION In many countries, MHWB is not taught or discussed in schools and youth-led mental health interventions are rare. Findings from this study reveal clear aspirations for participatory engagement to promote MHWB among young people in LMICs. To support meaningful participation, policymakers and youth service providers must ensure that young people have access to mental health literacy training and opportunities to raise awareness in schools or community settings.
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Affiliation(s)
- Gabriela Pavarini
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, Oxfordshire, United Kingdom.
| | - Chantelle Booysen
- Young Leaders for Global Mental Health, Durban, KawZulu-Natal, South Africa
| | - Tanvi Jain
- Maternal, Newborn, Adolescent Health Unit, UNICEF, New York, New York
| | - Joanna Lai
- Maternal, Newborn, Adolescent Health Unit, UNICEF, New York, New York
| | - Kiran Manku
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | | | - Grace Gatera
- Young Leaders for Global Mental Health, Kigali, Rwanda
| | | | - David Karorero
- Young Leaders for Global Mental Health, Mariager, Denmark
| | | | | | - Claudia Sartor
- Young Leaders for Global Mental Health, Johannesburg, Gauteng, South Africa
| | - Lian Zeitz
- Young Leaders for Global Mental Health, Seattle, Washington
| | | | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, Oxfordshire, United Kingdom
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Ona G, Berrada A, Bouso JC. Communalistic use of psychoactive plants as a bridge between traditional healing practices and Western medicine: A new path for the Global Mental Health movement. Transcult Psychiatry 2022; 59:638-651. [PMID: 34665080 DOI: 10.1177/13634615211038416] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Global Mental Health (GMH) movement aims to provide urgently needed treatment to those with mental illness, especially in low- and middle-income countries. Due to the complexity of providing mental health services to people from various cultures, there is much debate among GMH advocates regarding the best way to proceed. While biomedical interventions offer some degree of help, complementary approaches should focus on the social/community aspects. Many cultures conduct traditional rituals involving the communal use of psychoactive plants. We propose that these practices should be respected, protected, and promoted as valuable tools with regard to mental health care at the community level. The traditional use of psychoactive plants promotes community engagement and participation, and they are relatively affordable. Furthermore, the worldviews and meaning-making systems of local population are respected. The medical systems surrounding the use of psychoactive plants can be explained in biomedical terms, and many recently published clinical trials have demonstrated their therapeutic potential. Psychoactive plants and associated rituals offer potential benefits as complementary aspects of mental health services. They should be considered as such by international practitioners and advocates of the GMH movement.
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Affiliation(s)
- Genís Ona
- ICEERS - International Center for Ethnobotanical Education, Research, and Service, Barcelona, Spain.,Department of Anthropology, Philosophy and Social Work, Medical Anthropology Research Center (MARC), 16777Universitat Rovira i Virgili, Tarragona, Spain
| | - Ali Berrada
- Unidad de Medicina Interna, 16548Hospital del Mar, Barcelona, Spain
| | - José Carlos Bouso
- ICEERS - International Center for Ethnobotanical Education, Research, and Service, Barcelona, Spain.,Department of Anthropology, Philosophy and Social Work, Medical Anthropology Research Center (MARC), 16777Universitat Rovira i Virgili, Tarragona, Spain
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8
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Bakken V, Koposov R, Røst TB, Clausen C, Nytrø Ø, Leventhal B, Westbye OS, Koochakpour K, Mandahl A, Hafstad H, Skokauskas N. Attitudes of Mental Health Service Users Toward Storage and Use of Electronic Health Records. Psychiatr Serv 2022; 73:1013-1018. [PMID: 35291817 DOI: 10.1176/appi.ps.202100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Electronic health records (EHRs) are used for both clinical practice and research. Because mental health service users' views are underrepresented in perspectives on EHR use, the authors examined service users' awareness, attitudes, and opinions about EHR data storage and sharing. METHODS A mixed-methods, cross-sectional design was used to examine attitudes of 253 Norwegian mental health service users who were recruited online to complete a quantitative and qualitative (free-text) survey about EHR utilization. RESULTS Most participants were aware that EHRs were stored (95%) and shared (58%). Most thought that patients benefited from EHR storage (84%), trusted authorities with EHR sharing (71%), were willing to share their EHRs to help others (75%), felt they benefited from EHR sharing (75%), and thought EHR sharing was ethical for health care and research (71%). Fewer were aware of EHR sharing for research (36%), and 62% were aware that shared data were anonymized. Of the participants, 69% recognized privacy risks associated with sharing. Lack of transparency and skepticism about anonymization and misuse of EHR data were concerns and perceived risks. Mental health service users thought that EHRs should be shared for policy development (81%), education and training (85%), improving care quality (89%), research (91%), and clinical decision support (81%). CONCLUSIONS Participants were aware of and supported EHR sharing for research and clinical care. They supported sharing to help others and were willing to fully participate in clinical care and research, as well as to share EHR information for their own care, research, and the care of others.
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Affiliation(s)
- Victoria Bakken
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
| | - Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
| | - Thomas Brox Røst
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
| | - Carolyn Clausen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
| | - Øystein Nytrø
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
| | - Bennett Leventhal
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
| | - Odd Sverre Westbye
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
| | - Kaban Koochakpour
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
| | - Arthur Mandahl
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
| | - Hege Hafstad
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences (Bakken, Clausen, Westbye, Skokauskas), and Department of Computer Science (Nytrø, Koochakpour), Norwegian University of Science and Technology, Trondheim, Norway; RKBU Northern Norway, Arctic University of Norway, Tromsø (Koposov); Sechenov First Moscow State Medical University, Moscow (Koposov); Vivit AS, Trondheim, Norway (Røst); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Leventhal); Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway (Westbye); Vårres Regional User-Controlled Center of Central Norway, Trondheim, Norway (Mandahl, Hafstad)
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Happell B, Gordon S, Sharrock J, O'Donovan A, Warner T. 'What's she doing here?' Overcoming barriers to the implementation of Expert by Experience positions in academia. Aust Occup Ther J 2022; 69:689-702. [PMID: 35959799 PMCID: PMC10087197 DOI: 10.1111/1440-1630.12832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Experts by Experience involvement in the education of health professionals has gained momentum as an important strategy in ensuring quality, person-centred education. Despite being a requirement for occupational therapy programs in Australia and internationally, involvement is variable and limited. Barriers to the implementation of academic roles have been identified, including negative attitudes of colleagues, systemic barriers, and insufficient evidence of their value. Mental health academics who do not identify as having lived experience (referred to as allies) have provided crucial support for Experts by Experience. Understanding their perspectives on implementation barriers and how they can be addressed is crucial to facilitating a broader level of meaningful involvement. METHODS A qualitative exploratory research project was conducted, involving in-depth interviews with mental health academic allies (n = 16) from Australia, Ireland, and New Zealand. Participants were from the disciplines of nursing, occupational therapy, social work, and psychiatry. Data were analysed thematically. FINDINGS Two main themes were identified from the data analysis process: convincing colleagues and dealing with university barriers. Participants described varying attitudes from colleagues towards Experts by Experience, with many not understanding or appreciating their contribution to education and student outcomes. At the university level, reluctance to embrace innovation and funding and other resource shortages presented impediments to the implementation of Expert by Experience roles. Participants described using creative measures to overcome institutional barriers and encourage greater acceptance of such roles by colleagues. CONCLUSION This research describes how allies experienced and overcame barriers they faced when supporting the implementation of academic positions for Experts by Experience. Allies have an important role to play in overcoming systemic barriers, and the approaches they have taken to achieve this may be an important source of learning for others with similar aspirations.
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Affiliation(s)
- Brenda Happell
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia.,School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, Wellington, New Zealand
| | - Julie Sharrock
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,ACT Mental Health Consumer Network, Canberra, Australian Capital Territory, Australia
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Yamaguchi S, Abe M, Kawaguchi T, Igarashi M, Shiozawa T, Ogawa M, Yasuma N, Sato S, Miyamoto Y, Fujii C. Multiple stakeholders' perspectives on patient and public involvement in community mental health services research: A qualitative analysis. Health Expect 2022; 25:1844-1860. [PMID: 35657162 PMCID: PMC9327805 DOI: 10.1111/hex.13529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/19/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patient and public involvement (PPI) has become essential in health research. However, little is known about multiple stakeholders' perspectives on the implementation of PPI in community mental health research settings. The present study aimed to qualitatively analyse multiple stakeholders' views on PPI, including potential concerns, barriers and approaches. Methods This study involved conducting focus group interviews and collecting qualitative data from 37 participants in multiple stakeholder groups (patients = 6, caregivers = 5, service providers = 7, government staff = 5 and researchers = 14) in the community mental health field. The data were qualitatively analysed using a data‐driven approach that derived domains, themes and subthemes related to perspectives on PPI and to specific challenges and approaches for implementing PPI. Results The qualitative analysis identified four domains. The ‘Positive views and expectations regarding PPI’ domain consisted of themes related to supportive views of PPI in a mental health service research setting and improvements in the quality of research and service. The ‘General concerns about PPI’ domain included themes concerning the need for non‐PPI research and tokenism, excessive expectations concerning social changes and use of evidence from PPI research, and heavy burdens resulting from PPI. The ‘Specific issues regarding the implementation of PPI’ domain consisted of four themes, including academic systems, selection methods (e.g., representativeness and conflict of interest issues), relationship building, and ambiguous PPI criteria. In particular, all stakeholder groups expressed concerns about relational equality during PPI implementation in Japan. The ‘Approaches to PPI implementation’ domain included themes such as facilitating mutual understanding, creating a tolerant atmosphere, establishing PPI support systems (e.g., training, ethics and human resource matching) and empowering patient organizations. Conclusion The study replicated most of the barriers and approaches to PPI reported by qualitative research in Western counties. However, utilization of evidence produced by PPI research and partnership in the PPI process may be particularly serious issues in Japan. Future PPI studies should carefully address solutions that fit each culture. Patient or Public Contribution A patient‐researcher was involved in all stages of this project, from development of the research topic and the protocol to manuscript preparation.
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Affiliation(s)
- Sosei Yamaguchi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Makiko Abe
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Takayuki Kawaguchi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Momoka Igarashi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Takuma Shiozawa
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Makoto Ogawa
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Naonori Yasuma
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Sayaka Sato
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Chiyo Fujii
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Campion J, Javed A, Lund C, Sartorius N, Saxena S, Marmot M, Allan J, Udomratn P. Public mental health: required actions to address implementation failure in the context of COVID-19. Lancet Psychiatry 2022; 9:169-182. [PMID: 35065723 PMCID: PMC8776278 DOI: 10.1016/s2215-0366(21)00199-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022]
Abstract
Mental disorders account for at least 18% of global disease burden, and the associated annual global costs are projected to be US$6 trillion by 2030. Evidence-based, cost-effective public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent associated impacts of mental disorders (including through treatment), and promote mental wellbeing and resilience. However, only a small proportion of people with mental disorders receive minimally adequate treatment. Compared with treatment, there is even less coverage of interventions to prevent the associated impacts of mental disorders, prevent mental disorders from arising, or promote mental wellbeing and resilience. This implementation failure breaches the right to health, has increased during the COVID-19 pandemic, and results in preventable suffering, broad impacts, and associated economic costs. In this Health Policy paper, we outline specific actions to improve the coverage of PMH interventions, including PMH needs assessments, collaborative advocacy and leadership, PMH practice to inform policy and implementation, training and improvement of population literacy, settings-based and integrated approaches, use of digital technology, maximising existing resources, focus on high-return interventions, human rights approaches, legislation, and implementation research. Increased interest in PMH in populations and governments since the onset of the COVID-19 pandemic supports these actions. Improved implementation of PMH interventions can result in broad health, social, and economic impacts, even in the short-term, which support the achievement of a range of policy objectives, sustainable economic development, and recovery.
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Affiliation(s)
- Jonathan Campion
- South London and Maudsley NHS Foundation Trust, London, UK; Public Mental Health Implementation Centre, Royal College of Psychiatrists, London, UK.
| | - Afzal Javed
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Shekhar Saxena
- Department of Global Health and Population at the Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Michael Marmot
- Institute of Health Equity, Department of Epidemiology and Public Health, UCL, London, UK
| | - John Allan
- Office of the President, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia; Mental Health, Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia; Mayne Academy of Psychiatry, University of Queensland Medical School, University of Queensland, Brisbane, QLD, Australia
| | - Pichet Udomratn
- Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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12
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Evans JC, Evans MB, Slack M, Peddle M, Lingard L. Examining non-technical skills for ad hoc resuscitation teams: a scoping review and taxonomy of team-related concepts. Scand J Trauma Resusc Emerg Med 2021; 29:167. [PMID: 34863278 PMCID: PMC8642998 DOI: 10.1186/s13049-021-00980-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear whether—and how—these concepts impact resuscitation team performance. In the context of ad hoc teams in prehospital, emergency department, and trauma domains, even less is known about their relevance and impact. Methods This scoping review, guided by PRISMA-ScR and Arksey & O’Malley’s framework, included a systematic search across five databases, followed by article selection and extracting and synthesizing data. Articles were eligible for inclusion if they pertained to NTS for resuscitation teams performing in prehospital, emergency department, or trauma settings. Articles were subjected to descriptive analysis, coherence analysis, and citation network analysis. Results Sixty-one articles were included. Descriptive analysis identified fourteen unique non-technical skills. Coherence analysis revealed inconsistencies in both definition and measurement of various NTS constructs, while citation network analysis suggests parallel, disconnected scholarly conversations that foster discordance in their operationalization across domains. To reconcile these inconsistencies, we offer a taxonomy of non-technical skills for ad hoc resuscitation teams. Conclusion This scoping review presents a vigorous investigation into the literature pertaining to how NTS influence optimal resuscitation performance for ad hoc prehospital, emergency department, and trauma teams. Our proposed taxonomy offers a coherent foundation and shared vocabulary for future research and education efforts. Finally, we identify important limitations regarding the traditional measurement of NTS, which constrain our understanding of how and why these concepts support optimal performance in team resuscitation. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00980-5.
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Affiliation(s)
- J Colin Evans
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - M Blair Evans
- Department of Psychology, Western University, London, ON, Canada
| | - Meagan Slack
- Middlesex-London Paramedic Service, London, ON, Canada
| | - Michael Peddle
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Palmer VJ, Chondros P, Furler J, Herrman H, Pierce D, Godbee K, Densley K, Gunn JM. The CORE study-An adapted mental health experience codesign intervention to improve psychosocial recovery for people with severe mental illness: A stepped wedge cluster randomized-controlled trial. Health Expect 2021; 24:1948-1961. [PMID: 34350669 PMCID: PMC8628597 DOI: 10.1111/hex.13334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Mental health policies outline the need for codesign of services and quality improvement in partnership with service users and staff (and sometimes carers), and yet, evidence of systematic implementation and the impacts on healthcare outcomes is limited. OBJECTIVE The aim of this study was to test whether an adapted mental health experience codesign intervention to improve recovery-orientation of services led to greater psychosocial recovery outcomes for service users. DESIGN A stepped wedge cluster randomized-controlled trial was conducted. SETTING AND PARTICIPANTS Four Mental Health Community Support Services providers, 287 people living with severe mental illnesses, 61 carers and 120 staff were recruited across Victoria, Australia. MAIN OUTCOME MEASURES The 24-item Revised Recovery Assessment Scale (RAS-R) measured individual psychosocial recovery. RESULTS A total of 841 observations were completed with 287 service users. The intention-to-treat analysis found RAS-R scores to be similar between the intervention (mean = 84.7, SD= 15.6) and control (mean = 86.5, SD= 15.3) phases; the adjusted estimated difference in the mean RAS-R score was -1.70 (95% confidence interval: -3.81 to 0.40; p = .11). DISCUSSION This first trial of an adapted mental health experience codesign intervention for psychosocial recovery outcomes found no difference between the intervention and control arms. CONCLUSIONS More attention to the conditions that are required for eight essential mechanisms of change to support codesign processes and implementation is needed. PATIENT AND PUBLIC INVOLVEMENT The State consumer (Victorian Mental Illness Awareness Council) and carer peak bodies (Tandem representing mental health carers) codeveloped the intervention. The adapted intervention was facilitated by coinvestigators with lived-experiences who were coauthors for the trial and process evaluation protocols, the engagement model and explanatory model of change for the trial.
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Affiliation(s)
- Victoria J. Palmer
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
- The ALIVE National Centre for Mental Health Research TranslationThe University of MelbourneParkvilleVictoriaAustralia
| | - Patty Chondros
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
- The ALIVE National Centre for Mental Health Research TranslationThe University of MelbourneParkvilleVictoriaAustralia
| | - John Furler
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental HealthThe University of MelbourneParkvilleVictoriaAustralia
| | - David Pierce
- Department of Rural HealthThe University of MelbourneBallaratVictoriaAustralia
| | - Kali Godbee
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
| | - Konstancja Densley
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
- The ALIVE National Centre for Mental Health Research TranslationThe University of MelbourneParkvilleVictoriaAustralia
| | - Jane M. Gunn
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
- The ALIVE National Centre for Mental Health Research TranslationThe University of MelbourneParkvilleVictoriaAustralia
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Scott R, Aboud A. Engagement of mental health service users and carers in care planning - Is it meaningful and adding value? Australas Psychiatry 2021; 29:676-678. [PMID: 34266295 DOI: 10.1177/10398562211028646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Consider whether mental health service users and carers meaningfully engage in care planning and whether care planning adds value to patient care. CONCLUSION A review of the meta-analyses and systematic reviews of service users and carers identified many barriers to their meaningful engagement in care planning. No research has demonstrated any measurable benefits or positive outcomes linked to mental health care planning.
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Affiliation(s)
- Russ Scott
- Consultant Forensic Psychiatrist, Brisbane, QLD, Australia
| | - Andrew Aboud
- Consultant Forensic Psychiatrist, Brisbane, QLD, Australia
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15
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Pelto-Piri V, Kjellin L. Social inclusion and violence prevention in psychiatric inpatient care. A qualitative interview study with service users, staff members and ward managers. BMC Health Serv Res 2021; 21:1255. [PMID: 34801020 PMCID: PMC8605501 DOI: 10.1186/s12913-021-07178-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/15/2021] [Indexed: 11/27/2022] Open
Abstract
Background Many psychiatric services include social inclusion as a policy with the aim to offer users the opportunity to participate in care and to form reciprocal relationships. The aim of this study was to explore opportunities and problems with regard to participation, reciprocity and social justice that different stakeholders experience when it comes to social inclusion for service users and minimizing violence in psychiatric inpatient care. Methods Qualitative interviews were performed with 12 service users, 15 staff members, and six ward managers in three different kinds of psychiatric wards in Sweden. The data were analyzed using the framework method and qualitative content analysis, which was based on the three following social inclusion values: participation, reciprocity, and social justice. Results Themes and subthemes were inductively constructed within the three social inclusion values. For participation, staff and ward managers reported difficulties in involving service users in their care, while service users did not feel that they participated and worried about what would happen after discharge. Staff gave more positive descriptions of their relationships with service users and the possibility for reciprocity. Service users described a lack of social justice, such as disruptive care, a lack of support from services, not having access to care, or negative experiences of coercive measures. Despite this, service users often saw the ward as being safer than outside the hospital. Staff and managers reported worries about staffing, staff competence, minimizing coercion and violence, and a lack of support from the management. Conclusions By applying the tentative model on empirical data we identified factors that can support or disrupt the process to create a safe ward where service users can feel socially included. Our results indicate that that staff and service users may have different views on the reciprocity of their relationships, and that users may experience a lack of social justice. The users may, due to harsh living conditions, be more concerned about the risk of violence in the community than as inpatients. Staff and ward managers need support from the management to foster a sense of community in the ward and to implement evidence-based prevention programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07178-6.
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Affiliation(s)
- Veikko Pelto-Piri
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, 70182, Örebro, SE, Sweden.
| | - Lars Kjellin
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, 70182, Örebro, SE, Sweden
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Kohrt BA, Jordans MJD, Turner EL, Rai S, Gurung D, Dhakal M, Bhardwaj A, Lamichhane J, Singla DR, Lund C, Patel V, Luitel NP, Sikkema KJ. Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services: A Pilot Cluster Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2131475. [PMID: 34730821 PMCID: PMC8567115 DOI: 10.1001/jamanetworkopen.2021.31475] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Collaboration with people with lived experience of mental illness (PWLE), also referred to as service users, is a growing priority to reduce stigma and improve mental health care. OBJECTIVE To examine feasibility and acceptability of conducting an antistigma intervention in collaboration with PWLE during mental health training of primary care practitioners (PCPs). DESIGN, SETTING, AND PARTICIPANTS This pilot cluster randomized clinical trial was conducted from February 7, 2016, to August 10, 2018, with assessors, PCPs, and patients blinded to group assignment. The participants were PCPs and primary care patients diagnosed with depression, psychosis, or alcohol use disorder at primary care facilities (the cluster unit of randomization) in Nepal. Statistical analysis was performed from February 2020 to February 2021. INTERVENTIONS In the control group, PCPs were trained on the World Health Organization Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). In the Reducing Stigma Among Healthcare Providers (RESHAPE) group, the mhGAP-IG trainings for PCPs were cofacilitated by PWLE who presented recovery testimonials through photographic narratives. MAIN OUTCOMES AND MEASURES Prespecified feasibility and acceptability measures were adequacy of randomization, retention rates, intervention fidelity, data missingness, and safety. Outcome measures for PCPs included the Social Distance Scale (SDS), accuracy of diagnoses of mental illness in standardized role-plays using the Enhancing Assessment of Common Therapeutic factors tool (ENACT), and accuracy of diagnosis with actual patients. The primary end point was 16 months posttraining. RESULTS Among the overall sample of 88 PCPs, 75 (85.2%) were men and 67 (76.1%) were upper caste Hindus; the mean (SD) age was 36.2 (8.8) years. Nine of the PCPs (10.2%) were physicians, whereas the remaining 79 PCPs (89.8%) were health assistants or auxiliary health workers. Thirty-four facilities were randomized to RESHAPE or the control group. All eligible PCPs participated: 43 in RESHAPE and 45 in the control group, with 76.7% (n = 33) and 73.3% (n = 33) retention at end line, respectively. Due to PCP dropout, 29 facilities (85.3%) were included in end line analysis. Of 15 PWLE trained as cofacilitators, 11 (73.3%) participated throughout the 3 months of PCP trainings. Among PCPs, mean SDS changes from pretraining to 16 months were -10.6 points (95% CI, -14.5 to -6.74 points) in RESHAPE and -2.79 points (-8.29 to 2.70 points) in the control group. Role-play-based diagnoses with ENACT were 78.1% (25 of 32) accurate in RESHAPE and 66.7% (22 of 33) in the control group. Patient diagnoses were 72.5% (29 of 40) accurate by PCPs in RESHAPE compared with 34.5% (10 of 29) by PCPs in the control group. There were no serious adverse events. CONCLUSIONS AND RELEVANCE This pilot cluster randomized clinical trial found that procedures were feasible and acceptable for PCPs to be trained by PWLE. These pilot results will help inform a full trial to evaluate benefits of collaboration with PWLE during training of PCPs to reduce stigma and improve diagnostic accuracy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02793271.
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Affiliation(s)
- Brandon A. Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Mark J. D. Jordans
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- University of Amsterdam, Amsterdam, the Netherlands
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Sauharda Rai
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Jackson School of International Studies, Department of Global Health, University of Washington, Seattle
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Manoj Dhakal
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Anvita Bhardwaj
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Daisy R. Singla
- Campbell Family Mental Health Research Institute, Centre of Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Crick Lund
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Sangath, Goa, India
| | | | - Kathleen J. Sikkema
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
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Hipp K, Repo-Tiihonen E, Kuosmanen L, Katajisto J, Kangasniemi M. Patient participation in pro re nata medication in forensic psychiatric care: A nursing document analysis. J Psychiatr Ment Health Nurs 2021; 28:611-621. [PMID: 33085793 DOI: 10.1111/jpm.12706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/11/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT As-needed medication is commonly used for psychiatric inpatients' acute psychiatric and physical symptoms. Both patients and staff can initiate such medication. Earlier studies have focused on what and how as-needed medication has been used for psychiatric reasons. Little is known about how patients participate in planning, administration and evaluation of as-needed medication and its alternatives. Nursing documentation provides an insight into these practices. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE Long-term inpatients have an active role in initiating as-needed medication. However, patients and staff may have divergent opinions on the need for medication. Alternatives to medication are mostly proposed by staff, and the feedback on as-needed medication events is usually provided from nurses' point of view. WHAT ARE THE IMPLICATIONS FOR PRACTICE Patients' views on decision-making and evaluation should be noticed and documented more. Patient participation can be promoted by planning as-needed medication and its alternatives beforehand. ABSTRACT INTRODUCTION: Pro re nata (PRN) medication is unscheduled and used for acute physical and psychiatric symptoms. Previous studies have focused on the what and how of psychotropic PRN administration. Initiators of PRN events and occasions in which PRN was denied have rarely been studied. Thus, knowledge of patient participation in PRN is fragmented. AIM We aimed to describe and explain long-term psychiatric inpatients' participation in relation to planning and initiation of, as well as decisions and feedback on their PRN medication treatment. METHODS We retrieved data from patients' (n = 67) nursing documentation in a Finnish forensic psychiatric hospital in 2018. Data were analysed using statistical methods. RESULTS All patients were prescribed PRN, and they initiated half of the 8,626 PRN events identified, in a 1-year period. Non-pharmacological strategies were rarely (6%) documented, and most of them were initiated by staff (76%). Feedback on PRN was usually from a nurse's viewpoint (71%). Nurses' feedback was positive (80%) more often than patients' (50%). DISCUSSION Patient participation needs to be recognized throughout the PRN process. Future research could continue to explore patient participation in planning and evaluating their PRN medication. IMPLICATIONS FOR PRACTICE Patients participate in PRN by requesting medication. Their participation can be developed by supporting patients to communicate their choice of non-pharmacological methods, take the initiative for medication when needed and disclose their viewpoint on the effects of PRN.
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Affiliation(s)
- Kirsi Hipp
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Eila Repo-Tiihonen
- Niuvanniemi Hospital, Kuopio, Finland.,University of Eastern Finland, Kuopio, Finland.,University of Helsinki, Helsinki, Finland
| | - Lauri Kuosmanen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
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Selvin M, Almqvist K, Kjellin L, Schröder A. Patient participation in forensic psychiatric care: Mental health professionals' perspective. Int J Ment Health Nurs 2021; 30:461-468. [PMID: 33098186 PMCID: PMC7984362 DOI: 10.1111/inm.12806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
Patient participation is a central concept in modern health care and an important factor in theories/models such as person-centred care, shared decision-making, human rights approaches, and recovery-oriented practice. Forensic psychiatric care involves the treatment of patients with serious mental illnesses who also have committed a crime, and there are known challenges for mental health staff to create a health-promoting climate. The aim of the present study was to describe mental health professionals' perceptions of the concept of patient participation in forensic psychiatric care. Interviews were conducted with 19 professionals and were analysed with a phenomenographic approach. The findings are presented as three descriptive categories comprising five conceptions in an hierarchic order: 1. create prerequisites - to have good communication and to involve the patient, 2. adapt to forensic psychiatric care conditions - to take professional responsibility and to assess the patient's current ability, and 3. progress - to encourage the patient to become more independent. The findings highlight the need for professionals to create prerequisites for patient participation through good communication and involving the patient, whilst adapting to forensic psychiatric care conditions by taking professional responsibility, assessing the patient's ability, and encouraging the patient to become more independent without adding any risks to the care process. By creating such prerequisites adapted to the forensic psychiatric care, it is more likely that the patients will participate in their care and take more own responsibility for it, which also may be helpful in the patient recovery process.
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Affiliation(s)
- Mikael Selvin
- University Health Care Research CenterFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Kjerstin Almqvist
- Department for Social and Psychological StudiesKarlstad UniversityKarlstadSweden
| | - Lars Kjellin
- University Health Care Research CenterFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Agneta Schröder
- University Health Care Research CenterFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Department of Health ScienceFaculty of Health, Care and NursingNorwegian University of Science and Technology (NTNU)GjövikNorway
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Higgins A, Murphy R, Downes C, Barry J, Monahan M, Hevey D, Kroll T, Doyle L, Gibbons P. Factors impacting the implementation of a psychoeducation intervention within the mental health system: a multisite study using the consolidation framework for implementation research. BMC Health Serv Res 2020; 20:1023. [PMID: 33168003 PMCID: PMC7654573 DOI: 10.1186/s12913-020-05852-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. METHODS The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n = 75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. RESULTS Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. Important factors in the outer setting domain included structural stability within national systems and the peer payment system, while the extent of a recovery-oriented culture, leadership, implementation readiness, and buy-in were influential factors in the inner setting. The characteristics of the intervention in terms of design, evidence-base and adaptability also shaped the intervention's implementation as did the knowledge, beliefs and self-efficacy of facilitators. In terms of processes, implementation was influenced by the degree of engagement of key individuals who championed and supported the programme. The results highlight that while some of the barriers were specific to the programme, many reflected systemic and structural challenges within health services more generally. CONCLUSION Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.
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Affiliation(s)
- Agnes Higgins
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - Rebecca Murphy
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
- Department of Psychology, Maynooth University, Kiladre, Ireland
| | - Carmel Downes
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - Jennifer Barry
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - Mark Monahan
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
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20
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Allerby K, Goulding A, Ali L, Waern M. Striving for a more person-centered psychosis care: results of a hospital-based multi-professional educational intervention. BMC Psychiatry 2020; 20:523. [PMID: 33148190 PMCID: PMC7640678 DOI: 10.1186/s12888-020-02871-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reluctance on the part of mental health professionals constitutes an important barrier to patient participation in care. In order to stimulate person-centeredness in the inpatient care of persons with psychotic illness, we developed and tested an educational intervention for hospital staff (including psychiatrists) at all four wards at the Psychosis Clinic, Sahlgrenska University Hospital in Gothenburg, Sweden. The intervention was co-created by professionals, patients, and researchers using a participatory approach. In addition to lectures and workshops, staff created and implemented small projects to increase person-centeredness on their own wards. A primary focus was to establish a partnership between patient and staff by capturing and utilizing the patient's narrative to support active engagement in the care process. This included the development of a person-centered care plan. We hypothesized that the intervention would be associated with increased patient empowerment (primary outcome) and satisfaction with care (secondary outcome). METHODS A before and after design was used to test group differences in patient empowerment (Empowerment Scale) and consumer satisfaction (UKU-ConSat Rating Scale). All patients receiving inpatient psychosis care during measuring periods were eligible if meeting inclusion criteria of schizophrenia spectrum disorder, age > 18, and ability to comprehend study information. Severe cognitive deficit and inadequate Swedish language skills were exclusion criteria. Data on possible confounding variables including overall health (EQ-5D), symptom burden (PANSS), and functional ability (GAF) were collected alongside outcome measures. RESULTS ANCOVAs with overall health as a confounding variable showed no group differences regarding empowerment before (n = 50) versus after (n = 49) intervention, sample mean = 2.87/2.99, p = .142, eta2 = .02, CI = -.27-.04. Consumer satisfaction (n = 50/50) was higher in the post-implementation group (4.46 versus 11.71, p = .041 eta2 = .04, CI = -14.17- -.31). CONCLUSION The hypothesis regarding the primary outcome, empowerment, was not supported. An increase in the secondary outcome, satisfaction, was observed, although the effect size was small, and results should be interpreted with caution. Findings from this staff educational intervention can inform the development of future studies aimed at improvement of inpatient care for persons with severe mental illness. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov June 9, 2017, identifier: NCT03182283.
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Affiliation(s)
- Katarina Allerby
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345, Gothenburg, Sweden. .,Psychosis Department, Region Västra Göraland; Sahlgrenska University Hospital, 41345, Gothenburg, Sweden.
| | - Anneli Goulding
- grid.8761.80000 0000 9919 9582Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345 Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Department of Psychology, University of Gothenburg, Haraldsgatan 1, 41314 Gothenburg, Sweden
| | - Lilas Ali
- grid.8761.80000 0000 9919 9582Institute of Health Care Sciences, Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Box 100, 40530 Gothenburg, Sweden ,grid.1649.a000000009445082XPsychiatry Department, Region Västra Götaland, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Margda Waern
- grid.8761.80000 0000 9919 9582Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345 Gothenburg, Sweden ,grid.1649.a000000009445082XPsychosis Department, Region Västra Göraland; Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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21
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Thimm JC, Antonsen L, Malmedal W. Patients' perception of user involvement in psychiatric outpatient treatment: Associations with patient characteristics and satisfaction. Health Expect 2020; 23:1477-1484. [PMID: 32935451 PMCID: PMC7752195 DOI: 10.1111/hex.13132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The patient's right to be involved in treatment decisions is anchored in guidelines and legislation in many countries. Previous research suggests challenges in the implementation of user involvement across different areas of health care, including mental health. However, little is known about psychiatric outpatients' experiences of being involved in their treatment. OBJECTIVE To investigate how psychiatric outpatients after treatment rate the degree to which they were included in the treatment and explore the associations between perceived user involvement, demographic characteristics of the sample and patient satisfaction. DESIGN Cross-sectional. SETTING AND PARTICIPANTS The sample consisted of 188 psychiatric outpatients (67% female, mean age 42.2 years) who were discharged in the two years prior to data collection. MAIN VARIABLES STUDIED Perceived user involvement in psychiatric outpatient treatment and patient satisfaction as measured by the Psychiatric Out-Patient Experiences Questionnaire. RESULTS About half of the participants rated the overall degree of involvement in their treatment as high or very high. The lowest percentage of participants reporting high or very high involvement was found for sufficient information to contribute to treatment decisions (36%). Female gender, higher education and, to a small degree, younger age were associated with more involvement. Perceived user involvement was strongly associated with treatment satisfaction. DISCUSSION AND CONCLUSION The findings suggest that user involvement in psychiatric outpatient treatment can be improved. Patient information that facilitates user involvement should be given more attention. PATIENT OR PUBLIC CONTRIBUTION The hospital's user panel was involved in the development of items assessing user involvement.
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Affiliation(s)
- Jens C Thimm
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway.,Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Liss Antonsen
- Psychiatric Centre, Helgeland Hospital Trust Mo i Rana, Mo i Rana, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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22
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Fernández A, Serra L. [Community life for all: mental health, participation and autonomy. SESPAS Report 2020]. GACETA SANITARIA 2020; 34 Suppl 1:34-38. [PMID: 32921498 DOI: 10.1016/j.gaceta.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
The objective of this article is to critically reflect on the participation in community of people with a diagnosis of mental disorder from a human rights and community health perspective. Firstly, we review basic concepts such as community mental health and the meaning of participation, which is understood as an end and not as a mean. It is important to increase the participation of people with a diagnosis in community spaces beyond the classic circuit of mental health care. This implies to create and share knowledge in a collective, horizontal and consensual way among all the people involved, especially the diagnosed people themselves. Secondly, the experience of the group of women of Radio Nikosia is narrated in first person by the participants themselves. The main highlights of the group are its horizontality, flexibility, and that is a self-organized space outside the health system where it is possible to express oneself without fear of being judged. Processes of trust, recognition, joy, social support and health are generated. Members of the group meet fortnightly and discuss on different topics chosen by them, and take part in political actions for women's own rights such as participation in the media, in feminist calls, in training and talks. We exemplify that other ways of doing community mental health are possible. The challenges are to make them visible, to systemize them and to be able to assess the impact they have on the health not only of the participants, but also the community.
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Affiliation(s)
- Ana Fernández
- Servicio de Salud Comunitaria, Agencia de Salud Pública de Barcelona, Barcelona, España; Departamento de Psicología Clínica y de la Salud, Universidad Autónoma de Barcelona, Barcelona, España.
| | - Lucía Serra
- Asociación Socio Cultural Radio Nikosia, Grupo Esquizo Barcelona, La Electrodoméstica, Universitat Oberta de Catalunya, Barcelona, España
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Pocobello R, El Sehity T, Negrogno L, Minervini C, Guida M, Venerito C. Comparison of a co-produced mental health service to traditional services: A co-produced mixed-methods cross-sectional study. Int J Ment Health Nurs 2020; 29:460-475. [PMID: 31820569 PMCID: PMC7328716 DOI: 10.1111/inm.12681] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 11/28/2022]
Abstract
This study investigates the differences between a co-produced experimental mental health centre and traditional day centres. For this purpose, we used a collaborative and mixed-method approach in two complementary studies: (i) a quantitative cross-sectional study designed to compare users' hospitalization rates and their use of psychiatric medications and (ii) a qualitative study designed to explore and document the experienced differences between co-produced and traditional services. In the quantitative cross-sectional study, surveys were administered to 37 users of one co-produced mental health service and to 40 users of traditional mental health services. A negative binomial regression analysis was performed to examine the relationships between predictors and users' hospitalization rates. After adjusting for the potential confounders, users of the co-produced centre reported a 63.2% reduced rate of hospitalizations compared with users of traditional mental health services (P = 0.002). Furthermore, 39% of users of the co-produced centre reported a reduction or even withdrawal from psychiatric medications against 22% of the comparison group (P = 0.036). In the qualitative study, six main differences emerged from a thematic analysis of a large user-led focus group. In the participants' experiences, the co-produced service focused on (i) parity and respectful relationships, (ii) people's strengths, (iii) freedom, (iv) psychological continuity, (v) social inclusion, and (vi) recovery orientation. Our research provides empirical evidence concerning the 'preventive aspect' of co-produced mental health services. Additionally, new insights into how different stakeholders, particularly users of co-produced mental health services, experience the differences between co-produced and traditional mental health services are provided.
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Affiliation(s)
- Raffaella Pocobello
- Istituto di Scienze e Tecnologie della Cognizione Consiglio Nazionale delle Ricerche, Rome, Italy
| | - Tarek El Sehity
- Istituto di Scienze e Tecnologie della Cognizione Consiglio Nazionale delle Ricerche, Rome, Italy.,Faculty of Psychology, Sigmund Freud University, Vienna, Austria
| | | | - Carlo Minervini
- ASL Brindisi - CSM, Brindisi, Italy.,Associazione 180Amici, Latiano Brindis, Italy
| | - Maddalena Guida
- ASL Brindisi - CSM, Brindisi, Italy.,Associazione 180Amici, Latiano Brindis, Italy
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24
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Hall T, Kakuma R, Palmer L, Minas H, Martins J, Armstrong G. Service user and family participation in mental health policy making in Timor-Leste: a qualitative study with multiple stakeholders. BMC Psychiatry 2020; 20:117. [PMID: 32164633 PMCID: PMC7069011 DOI: 10.1186/s12888-020-02521-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participation in mental health system strengthening by people with mental health problems and their families is a cornerstone of people-centred mental health care, yet there is a dearth of research about participation from low- and middle-income countries (LMICs), particularly from the Asia Pacific region. Hence, this study aimed to assess the current situation, challenges, enabling factors and future actions for service user and family participation in mental health policy making in Timor-Leste. METHODS In-depth interviews were conducted with 85 adults (≥18 years) who were: (1) mental health service users (n = 20) and their families (n = 10); (2) government decision makers (n = 10); (3) mental health and social service providers (n = 23); (4) civil society (n = 9); and (5) other groups (n = 13). Interview data was analysed using framework analysis. RESULTS There was limited service user, family and community participation in mental health policy making in Timor-Leste. Perceptions that policy making is a technical exercise and that people with mental health problems lack cognitive capacity, and a lack of supportive mechanisms challenged participation. Enabling factors were a strong focus on human rights within the social sector, and existing mechanisms for advocacy and representation of people with disabilities in social policy making. Participants suggested bolstering civil society representation of people with mental health problems, and increasing mental health awareness and literacy, including government competencies to facilitate service user participation. CONCLUSION The findings highlight the need for theoretical and practical focus on the role of family within mental health system development in LMICs. Global mental health research and practice should adopt a critical approach to mental health service user and family participation to ensure that the concept and strategies to achieve this are embedded in LMIC knowledge.
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Affiliation(s)
- Teresa Hall
- Nossal Institute for Global Health, The University of Melbourne, Exhibition Street, Melbourne, 3004, Australia.
| | - Ritsuko Kakuma
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK ,grid.1008.90000 0001 2179 088XCentre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - Lisa Palmer
- grid.1008.90000 0001 2179 088XSchool of Geography, The University of Melbourne, Melbourne, Australia
| | - Harry Minas
- grid.1008.90000 0001 2179 088XCentre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - João Martins
- grid.449369.5Faculty of Medicine and Health Sciences, National University of Timor-Leste, Dili, Timor-Leste
| | - Greg Armstrong
- grid.1008.90000 0001 2179 088XNossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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25
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Triliva S, Ntani S, Giovazolias T, Kafetsios K, Axelsson M, Bockting C, Buysse A, Desmet M, Dewaele A, Hannon D, Haukenes I, Hensing G, Meganck R, Rutten K, Schønning V, Van Beveren L, Vandamme J, Øverland S. Healthcare professionals' perspectives on mental health service provision: a pilot focus group study in six European countries. Int J Ment Health Syst 2020; 14:16. [PMID: 32165920 PMCID: PMC7060571 DOI: 10.1186/s13033-020-00350-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 02/29/2020] [Indexed: 12/11/2022] Open
Abstract
Background The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it. Methods Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners. Results The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative ‘chain of care’. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence. Conclusions The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people’s needs throughout their lives is an essential aspect of optimal care provision.
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Affiliation(s)
- Sofia Triliva
- 1Department of Psychology, University of Crete, 74100 Rethymno, Crete, Greece
| | - Spyridoula Ntani
- 1Department of Psychology, University of Crete, 74100 Rethymno, Crete, Greece
| | | | | | - Malin Axelsson
- 2Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Claudi Bockting
- 3Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,4Institute for Advanced Studies, University of Amsterdam, Amsterdam, The Netherlands
| | - Ann Buysse
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- 6Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Alexis Dewaele
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Dewi Hannon
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Inger Haukenes
- 7Research Unit for General Practice, NORCE-Norwegian Research Centre, Bergen, Norway.,8Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gunnel Hensing
- 9Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Reitske Meganck
- 6Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Kris Rutten
- 10Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Viktor Schønning
- 9Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,11Division of Mental and Physical Health, Norwegian Institute of Public Health & Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Laura Van Beveren
- 10Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Joke Vandamme
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Simon Øverland
- 11Division of Mental and Physical Health, Norwegian Institute of Public Health & Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Marais DL, Quayle M, Petersen I. Making consultation meaningful: Insights from a case study of the South African mental health policy consultation process. PLoS One 2020; 15:e0228281. [PMID: 31995612 PMCID: PMC6988953 DOI: 10.1371/journal.pone.0228281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/12/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND It is widely recognised that mental health policies should be developed in consultation with those tasked with their implementation and the users affected by them. In the South African legislative context public participation in policymaking is assumed, with little guidance on how to conduct consultation processes, nor how to use consultation inputs in policy decisions. METHODS The South African Mental Health Policy Framework and Strategic Plan was adopted in 2013 after an extensive consultation process. Focussing on the 2012 provincial and national consultation summit, this case-study conducted key informant interviews and undertook documentary analysis to explore the process through which consultation inputs were-or were not-transferred to inform this policy. Between 2013 and 2016 seven interviews were conducted, and 11 documents (policy drafts and summit outputs) and transcripts of 23 audio-recorded sessions from the national summit were analysed. RESULTS Findings revealed that no substantive changes were made to the mental health policy following the consultation summits. There do not seem to have been systematic processes for facilitating and capturing knowledge inputs, or for transferring these inputs between provincial and national levels. There was also no further consultation regarding priorities identified for implementation prior to finalisation of the policy, with participants highlighting concerns about policy implementation at local levels as a result. This represents a lost opportunity for greater involvement of service users in policy development. CONCLUSIONS Together with poor service-user representation, the format of the consultation process limited participant interaction and the possibility for engagement with, or uptake of, more experiential forms of knowledge. Several procedural elements were found to limit the elicitation and transference of consultation contributions for uptake into policy. Recommendations for future policy consultations include adapting the format of participatory processes to enable optimal use of participant knowledge, as well as greater service-user participation.
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Affiliation(s)
- Debra Leigh Marais
- Undergraduate Research Office, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael Quayle
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
- Department of Psychology, School of Applied Human Sciences University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Inge Petersen
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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27
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Abayneh S, Lempp H, Hanlon C. Participatory action research to pilot a model of mental health service user involvement in an Ethiopian rural primary healthcare setting: study protocol. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:2. [PMID: 31934350 PMCID: PMC6951014 DOI: 10.1186/s40900-019-0175-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Involvement of service-users at all levels of the mental health system is a policy imperative in many countries internationally. However, putting policy into practice seems complex; little is known about how best to involve service users and efforts are often criticized for being tokenistic. In low-and-middle income countries, less attention has been given to the roles of service users within mental health systems. The proposed study is part of a larger project intended to develop service-user involvement in mental health system strengthening in Ethiopia. A Theory of Change (ToC) model has already been developed through a participatory approach. This study protocol aims to describe the theoretical background and methods to pilot this model using participatory action research (PAR) and explore participants' experience of involvement. METHODS The proposed study will apply a PAR approach situated in critical social theory and conduct a phenomenological case study to find out participants' experience of involvement. This will be conducted in three stages. The focus of Stage 1 will be to(i) establish a Research Advisory Group (RAG), and Research Participant Group (RPG) at district and primary healthcare facility levels, respectively, and (ii) identify and prioritize potential areas of concern for involvement in the domains of advocacy, service planning and development, monitoring and improving service quality. In Stage 2, we will work with the RPG to develop a plan of action for the selected area. Stage 3 will aim to assist the RPG to implement and evaluate the plan of action. Process indicators and observation will be combined with in-depth interviews with participants to elicit their experiences of involvement. Thematic content analysis will be used. DISCUSSION The participatory approach to mental health service user involvement in health system strengthening employed by this study will support the implementation of solutions through locally relevant and contextualized actions. Findings from this study will contribute to the body of knowledge towards understanding the complexity of implementation of service user involvement and refine the ToC model for transferability to similar settings.
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Affiliation(s)
- Sisay Abayneh
- College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- King’s College London, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, Weston Education Centre, 10, Cutcombe Rd, London, SE5 9RJ UK
| | - Charlotte Hanlon
- College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa University, Addis Ababa, Ethiopia
- King’s College London, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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28
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Barr KR, Jewell M, Townsend ML, Grenyer BFS. Living with personality disorder and seeking mental health treatment: patients and family members reflect on their experiences. Borderline Personal Disord Emot Dysregul 2020; 7:21. [PMID: 32944249 PMCID: PMC7487914 DOI: 10.1186/s40479-020-00136-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite effective treatments for personality disorders being developed, consumers and carers often report negative experiences of mental health services, including challenges accessing these treatments. METHODS This qualitative study used separate focus groups to compare the unique perspectives of consumer and carers, and to investigate how to improve services for individuals with personality disorders. Reflexive thematic analysis was used to analyze the data. RESULTS Both consumers and carers (N = 15) discussed the value of providing appropriate information to consumers when they are diagnosed with personality disorder. Consumers and carers described the importance of creating a safe environment for consumers when they present to the emergency department. Both groups discussed experiencing positive and negative treatment from mental health professionals, and suggested that professionals should be trained to understand personality disorder. Limited accessibility and quality of services, and offering peer support to consumers were also described by consumers and carers. Consumers and carers also had perspectives which were unique to their group. Consumers identified the importance of psychological treatment, having a strong therapeutic relationship with a mental health professional, and the benefit of long term psychotherapy with the same professional. Broadening the scope of psychotherapies including creative, animal-assisted, and physical therapies was recommended by consumers. Carers described the importance of assessing for personality disorder and intervening early. Involvement in the assessment, diagnosis, and intervention process was important to carers. The desire to be recognized and supported by mental health professionals was discussed by carers. CONCLUSIONS This research contributes to the concern that consumers with personality disorder and their carers experience stigma and low quality care within mental health services. In line with these findings, we recommend guidelines for health professionals who work with consumers with personality disorder.
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Affiliation(s)
- Karlen R Barr
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Mahlie Jewell
- Project Air Strategy Consumer and Carer Advisory Committee, Wollongong, NSW Australia
| | - Michelle L Townsend
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia
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29
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Sather EW, Iversen VC, Svindseth MF, Crawford P, Vasset F. Patients' perspectives on care pathways and informed shared decision making in the transition between psychiatric hospitalization and the community. J Eval Clin Pract 2019; 25:1131-1141. [PMID: 31144419 DOI: 10.1111/jep.13206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/12/2019] [Accepted: 05/18/2019] [Indexed: 12/31/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Patients with mental health problems experience numerous transitions into and out of hospital. This study explores former patients' views of pathways in transition between district psychiatric hospital centres (DPCs) and community mental health services. METHOD A descriptive qualitative design was chosen. Three focus group interviews with a total of 10 informants from five different communities were conducted. Interviews were transcribed and analysed thematically where themes describe promoting or inhibitory factors to the transition phase. RESULTS The informants shared their experiences on issues promoting and preventing successful care pathways in mental health. Four main paired themes were identified: (a) patient participation/activation/empowerment versus paternalism and institutionalization, (b) patient-centred care versus care interpreted as humiliation, (c) interprofessional collaboration or teamwork versus unsafe patient pathways in mental health services, and (d) sustainable integrated care versus fragmented, noncollaborative care. CONCLUSIONS Shared decision making was reported more precisely as informed shared decision making. Shared information between all parties involved in care pathways is key.
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Affiliation(s)
- Eva W Sather
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Valentina C Iversen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Mental Health, St Olav's University Hospital HF, Tiller District Psychiatric Centre, Trondheim, Norway
| | - Marit F Svindseth
- Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Aalesund, Norway
| | - Paul Crawford
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Froydis Vasset
- Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Aalesund, Norway
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30
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Kerner B, Crisanti AS, DeShaw JL, Ho JMG, Jordan K, Krall RL, Kuntz MJ, Mazurie AJ, Nestsiarovich A, Perkins DJ, Schroeter QL, Smith AN, Tohen M, Volesky E, Zhu Y, Lambert CG. Preferences of Information Dissemination on Treatment for Bipolar Disorder: Patient-Centered Focus Group Study. JMIR Ment Health 2019; 6:e12848. [PMID: 31237566 PMCID: PMC6614999 DOI: 10.2196/12848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/15/2019] [Accepted: 03/29/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Patient education has taken center stage in successfully shared decision making between patients and health care providers. However, little is known about how patients with bipolar disorder typically obtain information on their illness and the treatment options available to them. OBJECTIVE This study aimed to obtain the perspectives of patients with bipolar disorder and their family members on the preferred and most effectively used information channels on bipolar disorder and the available treatment options. METHODS We conducted nine focus groups in Montana, New Mexico, and California, in which we surveyed 84 individuals including patients with bipolar disorder and family members of patients with bipolar disorder. The participants were recruited using National Alliance on Mental Illness mailing lists and websites. Written verbatim responses to semistructured questionnaires were analyzed using summative content analysis based on grounded theory. Two annotators coded and analyzed the data on the sentence or phrase level to create themes. Relationships between demographics and information channel were also examined using the Chi-square and Fisher exact tests. RESULTS The focus group participants mentioned a broad range of information channels that were successfully used in the past and could be recommended for future information dissemination. The majority of participants used providers (74%) and internet-based resources (75%) as their main information sources. There was no association between internet use and basic demographics such as age or geographical region of the focus groups. Patients considered time constraints and the fast pace in which an overwhelming amount of information is often presented by the provider as major barriers to successful provider-patient interactions. If Web-based channels were used, the participants perceived information obtained through Web-based channels as more helpful than information received in the provider's office (P<.05). CONCLUSIONS Web-based resources are increasingly used by patients with bipolar disorder and their family members to educate themselves about the disease and its treatment. Although provider-patient interactions are frequently perceived to be burdened with time constraints, Web-based information sources are considered reliable and helpful. Future research should explore how high-quality websites could be used to empower patients and improve provider-patient interactions with the goal of enhancing shared decision making between patients and providers.
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Affiliation(s)
- Berit Kerner
- Semel Institute, University of California, Los Angeles, CA, United States
| | - Annette S Crisanti
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Jason L DeShaw
- National Alliance on Mental Illness Montana, Helena, MT, United States
| | | | - Kimmie Jordan
- National Alliance on Mental Illness New Mexico, Albuquerque, NM, United States
| | - Ronald L Krall
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Matt J Kuntz
- National Alliance on Mental Illness Montana, Helena, MT, United States
| | | | - Anastasiya Nestsiarovich
- Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Douglas J Perkins
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | | | - Alicia N Smith
- National Alliance on Mental Illness Montana, Helena, MT, United States
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Emma Volesky
- National Alliance on Mental Illness Montana, Helena, MT, United States
| | - Yiliang Zhu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Christophe G Lambert
- Division of Translational Informatics, Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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31
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Pelto-Piri V, Wallsten T, Hylén U, Nikban I, Kjellin L. Feeling safe or unsafe in psychiatric inpatient care, a hospital-based qualitative interview study with inpatients in Sweden. Int J Ment Health Syst 2019; 13:23. [PMID: 30996733 PMCID: PMC6452515 DOI: 10.1186/s13033-019-0282-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023] Open
Abstract
Background A major challenge in psychiatric inpatient care is to create an environment that promotes patient recovery, patient safety and good working environment for staff. Since guidelines and programs addressing this issue stress the importance of primary prevention in creating safe environments, more insight is needed regarding patient perceptions of feeling safe. The aim of this study is to enhance our understanding of feelings of being safe or unsafe in psychiatric inpatient care. Methods In this qualitative study, interviews with open-ended questions were conducted with 17 adult patients, five women and 12 men, from four settings: one general psychiatric, one psychiatric addiction and two forensic psychiatric clinics. The main question in the interview guide concerned patients' feelings of being safe or unsafe. Thematic content analysis with an inductive approach was used to generate codes and, thereafter, themes and subthemes. Results The main results can be summarized in three themes: (1) Predictable and supportive services are necessary for feeling safe. This concerns the ability of psychiatric and social services to meet the needs of patients. Descriptions of delayed care and unpredictable processes were common. The structured environment was mostly perceived as positive. (2) Communication and taking responsibility enhance safety. This is about daily life in the ward, which was often perceived as being socially poor and boring with non-communicative staff. Participants emphasized that patients have to take responsibility for their actions and for co-patients. (3) Powerlessness and unpleasant encounters undermine safety. This addresses the participants' way of doing risk analyses and handling unpleasant or aggressive patients or staff members. The usual way to act in risk situations was to keep away. Conclusions Our results indicate that creating reliable treatment and care processes, a stimulating social climate in wards, and better staff-patient communication could enhance patient perceptions of feeling safe. It seems to be important that staff provide patients with general information about the safety situation at the ward, without violating individual patients right to confidentiality, and to have an ongoing process that aims to create organizational values promoting safe environments for patients and staff.
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Affiliation(s)
- Veikko Pelto-Piri
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tuula Wallsten
- 2Centre for Clinical Research, Uppsala University, County Hospital Västerås, Västerås, Sweden
| | - Ulrika Hylén
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Lars Kjellin
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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32
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Zaini S, Manivanna Bharathy HA, Sulaiman AH, Singh Gill J, Ong Hui K, Zaman Huri H, Shamsudin SH, Chong Guan N. Development of a Strategic Tool for Shared Decision-Making in the Use of Antidepressants among Patients with Major Depressive Disorder: A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071402. [PMID: 29970848 PMCID: PMC6068982 DOI: 10.3390/ijerph15071402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 01/22/2023]
Abstract
Shared decision-making (SDM) has been recognized as an important tool in the mental health field and considered as a crucial component of patient-centered care. Therefore, the purpose of this study was to develop a strategic tool towards the promotion and implementation of SDM in the use of antidepressants among patients with major depressive disorder. Nineteen doctors and 11 major depressive disorder patients who are involved in psychiatric outpatient clinic appointments were purposively selected and recruited to participate in one of six focus groups in a large teaching hospital in Malaysia. Focus groups were transcribed verbatim and analyzed using a thematic approach to identify current views on providing information needed for SDM practice towards its implementation in near future. Patients’ and doctors’ views were organized into six major themes, which are; summary of treatment options, correct ways of taking medication, potential side effects of treatments related to patients, sharing of case study related to the treatment options, cost of treatment options, and input from pharmacist. The information may be included in the SDM tool which can be useful to inform further research efforts and developments that contribute towards the successful implementation of SDM into clinical practice.
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Affiliation(s)
- Syahrir Zaini
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia.
| | | | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Jesjeet Singh Gill
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Koh Ong Hui
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Hasniza Zaman Huri
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Siti Hadijah Shamsudin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia.
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
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